- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $524.81 / $4,466.84
| Facility | | $302.00 | $524.81 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | 50 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $302.00 / $602.56
| Professional | | $194.98 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $416.87 / $912.01 / $1,174.90
| Professional | 50 | $416.87 | $912.01 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $338.84 / $478.63
| Professional | | $204.17 | $338.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $407.38
| Professional | | $32.36 | $33.11 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $2,238.72
| Facility | | $831.76 | $977.24 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $3,388.44
| Facility | 50 | $1,258.93 | $1,479.11 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $407.38 / $707.95
| Professional | | $288.40 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $616.60
| Professional | | $229.09 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $295.12 / $426.58
| Professional | | $154.88 | $295.12 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $275.42 / $416.87
| Professional | | $204.17 | $275.42 | $416.87 |